Tendonitis Of the Elbow

By Sohaila Mosaddegh, DPT

Elbow pain usually isn't serious, but because you use your elbow in so many ways, elbow pain can definitely affect your life. Your elbow is a complex joint that allows you to extend and flex your forearm and rotate your hand and forearm. Most movements are a combination of these actions, and you may sometimes find it difficult to describe what exactly brings on the pain.

If tendonitis is severe and leads to the rupture of a tendon, you may need surgical repair. But most cases of tendonitis can be successfully treated with rest, physical therapy and medications to reduce pain.

While epicondylitis (tendonitis of elbow) is typically considered benign and self-limiting, research has noted very high healthcare reutilization rates. Patients often resort to working through pain or foregoing formerly enjoyable exercise. Work-related upper extremity conditions that are not thoroughly rehabilitated can result in worker's compensation claims, unemployment, and underemployment.

Both medial and lateral epicondylitis (tennis and golfer's elbow) usually results from cumulative trauma and overuse. Doctors have connected epicondylitis with golf, tennis, swimming, pitching, hammering, using a screwdriver, typing, and excessive handshaking. When patients wish to resume repetitive stress activities, a basic return to previous function may not be enough.

To help patients return to daily activities, sports and protect patient's jobs, physical therapy is often required. In what seems to be the most recent study comparing corticosteroid injections to physical therapy, Tonks and colleagues declare in the title that steroid injection is the best. Unfortunately, this study published by the International Journal of Clinical Practice only followed patients for seven weeks.

To date, the largest and longest study comparing corticosteroid injections to physical therapy for epicondylitis is one published by the Lancet in 2002. In this study, Smidt et al. compared three treatments for lateral epicondylitis corticosteroid injections, physical therapy, and self-management. Injections had the greatest success rate at six weeks 92%. However, at a 52-week follow-up, the success for injections had dropped below physical therapy success rates.

In addition, it was later demonstrated that adding spinal manipulation to traditional extremity therapies improves physical therapy results in terms of ability, grip strength, and pain. It may be reasonable to combine analgesic treatment with rehabilitative treatment to achieve the best in both immediate and long-term success.